Provider Demographics
NPI:1992029763
Name:PETERSON, ALLISON KAY (MA, LP)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:KAY
Last Name:PETERSON
Suffix:
Gender:F
Credentials:MA, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 METRO BLVD STE 190
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-2361
Mailing Address - Country:US
Mailing Address - Phone:612-486-2956
Mailing Address - Fax:888-974-1262
Practice Address - Street 1:7400 METRO BLVD STE 190
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439-2361
Practice Address - Country:US
Practice Address - Phone:612-486-2956
Practice Address - Fax:888-974-1262
Is Sole Proprietor?:No
Enumeration Date:2010-03-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP5049103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling